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    <title>订舱反馈 | </title>

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<body class="nav-md">
<div class="container body">
    <div class="main_container">
        <div id="head">

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        <!-- page content -->
        <div class="right_col" role="main">
            <div class="">
                <div class="page-title">
                    <div class="title_left">
                        <h3>订舱反馈</h3>
                    </div>


                </div>
                <div class="clearfix"></div>

                <div class="row">
                    <div class="col-md-12 col-sm-12 col-xs-12">
                        <div class="x_panel">

                            <div class="x_content">

                                <form class="form-horizontal form-label-left" novalidate>


                                    <span class="section">订舱反馈</span>

                                    <div class="item form-group">
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="name">SO  NO
                                        </label>
                                        <div class="col-md-6 col-sm-6 col-xs-12">
                                            <input id="name" class="form-control col-md-7 col-xs-12" data-validate-length-range="6" data-validate-words="2" name="name"  required="required" type="text">
                                        </div>
                                    </div>
                                    <div class="item form-group" >
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="email">船公司
                                        </label>
                                        <div class=" col-xs-9" id="email">
                                            <select  style="height: 30px;width: 100px;padding-left: 10px" >
                                                <option>--请选择--</option>
                                                <option>海天船公司</option>
                                                <option>雄鹰船公司</option>
                                                <option>深蓝船公司</option>
                                            </select>

                                        </div>
                                    </div>
                                    <div class="item form-group">
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="email">船&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;名
                                        </label>
                                        <div class="col-md-6 col-sm-6 col-xs-12">
                                            <input type="text" id="email2" name="confirm_email" data-validate-linked="email" required="required" class="form-control col-md-7 col-xs-12">
                                        </div>
                                    </div>
                                    <div class="item form-group">
                                       
                                    </div>
                                    <div class="item form-group">
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="website">船&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;次
                                        </label>
                                        <div class="col-md-6 col-sm-6 col-xs-12">
                                            <input type="text" id="website" name="website" required="required" class="form-control col-md-7 col-xs-12">
                                        </div>
                                    </div>
                                    
                                   
                                    <div class="item form-group">
                                        <label for="password2" class="control-label col-md-3 col-sm-3 col-xs-12">ETD(离港时间)</label>
                                        <div class="col-md-6 col-sm-6 col-xs-12">
                                            <input id="password2" type="text" name="password2"  data-validate-linked="password" class="form-control col-md-7 col-xs-12" required="required">
                                        </div>
                                    </div>
                                    <div class="item form-group">
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="telephone">ETA(预计到达时间)
                                        </label>
                                        <div class="col-md-6 col-sm-6 col-xs-12">
                                            <input type="text" id="telephone" name="phone" required="required" data-validate-length-range="8,20" class="form-control col-md-7 col-xs-12">
                                        </div>
                                    </div>
                                    <div class="item form-group" >
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="email3">箱&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;型
                                        </label>
                                        <div class=" col-xs-9" id="email3">
                                            <select  style="height: 30px;width: 100px;padding-left: 10px" >
                                                <option>--请选择--</option>
                                                <option>海天船公司</option>
                                                <option>雄鹰船公司</option>
                                                <option>深蓝船公司</option>
                                            </select>

                                        </div>
                                    </div>
                                    <div class="item form-group" >
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="email4">箱&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;量
                                        </label>
                                        <div class=" col-xs-9" id="email4">
                                            <select  style="height: 30px;width: 100px;padding-left: 10px" >
                                                <option>--请选择--</option>
                                                <option>海天船公司</option>
                                                <option>雄鹰船公司</option>
                                                <option>深蓝船公司</option>
                                            </select>

                                        </div>
                                    </div>
                                    <div class="item form-group" >
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="email5">尺&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;寸
                                        </label>
                                        <div class=" col-xs-9" id="email5">
                                            <select  style="height: 30px;width: 100px;padding-left: 10px" >
                                                <option>--请选择--</option>
                                                <option>海天船公司</option>
                                                <option>雄鹰船公司</option>
                                                <option>深蓝船公司</option>
                                            </select>

                                        </div>
                                    </div>
                                    
                                    <div class="item form-group">
                                        <label class="control-label col-md-3 col-sm-3 col-xs-12" >截关时间
                                        </label>
                                        <div class="col-md-6 col-sm-6 col-xs-12">
                                            <input type="date" id="telephone2" name="phone" required="required" data-validate-length-range="8,20" class="form-control col-md-7 col-xs-12">
                                        </div>
                                    </div>
                                  

                                    <div class="ln_solid"></div>
                                    <div class="form-group">
                                        <div class="col-md-6 col-md-offset-3">
                                            <button id="send" type="submit" class="btn btn-success">保存</button>
											<button type="button" class="btn btn-primary" onclick="window.history.back(-1)">返回</button>

                                        </div>
                                    </div>
                                </form>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
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        <footer>
            <div class="pull-right">
                Gentelella - Bootstrap Admin Template by <a href="https://colorlib.com">Colorlib</a>
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